Revision arthroplasty of the knee in Awka, southeast, Nigeria: Prevalence, etiology, and treatment outcome

Introduction: Total Knee Arthroplasty (TKA) is effective for severe knee osteoarthritis, with a typical 10-year revision risk of around 5-5.5%. Rising revision rates are linked to increased TKA procedures and younger patient demographics. With improvements in implant design and reduction of implant wear,the main revision causes is now aseptic loosening. Others include instability, malalignment, and infection. Advances in implant technology have reduced polyethene wear issues, but technical errors during surgery remain a problem. The study aims to examine the increasing need for revisions in Nigeria, considering the local context of varying surgical expertise.
Methodology: In Awka, Nigeria, 134 patients with 156 knees were assessed at an orthopedic center for knee pathologies. Evaluations included medical histories, physical exams, and tests like C-reactive protein screening and intraoperative aspirations to determine pathology causes. Three cases involved failed knee arthroplasties requiring revisions with specific prosthesis types, with follow-ups spanning 5 to 7 years.
Result: This study from Awka, Nigeria, focused on 156 knee surgery cases, showing a low revision rate of 1.92% compared to 5-5.5% internationally. The mean patient age was 60.33 years, indicating early onset complications. Technical failures, not implant wear, primarily drove revisions. Patients, all female, faced significant declines in quality of life and often presented late for surgery, leading to complex revision cases requiring intensive care and specific implants like the LCCK for aseptic loosening or tumor implants for severe osteolysis. Postoperative care included long-term follow-up, averaging 3 to 7 years, with generally positive outcomes.
Conclusion: The revision surgeries were due to technical failures rather than implant wear. There is remarkably low revision rate of 1.92% highlighting the regional success despite challenging conditions.